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KMID : 1103720180790060315
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Journal of the Korean Society of Radiology
2018 Volume.79 No. 6 p.315 ~ p.322
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Clinical and Angiographic Features of Secondary Postpartum Hemorrhage and the Outcomes of Transcatheter Arterial Embolization
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Baek Seung-Dae
Kang Ung-Rae
Ji Seung-Woo
Kim Young-Hwan
Cha Jung-Guen
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Abstract
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Purpose: To analyze the clinical and angiographic features with outcome of transcatheter arterial embolization in patients with secondary postpartum hemorrhage.
Materials and Methods: Clinical details and angiographic features with assessment of arterial embolization were reviewed in total 38 patients underwent arterial embolization at single tertiary referral center.
Results: Twenty patients (53%) had Cesarean section. The major causes of bleeding were iatrogenic vascular injury, and retained placenta (55%). The patterns of vaginal bleeding were recorded as intermittent (50%), or as persistent (50%). Seven patients (18%) were hemodynamically unstable at presentation. Positive angiographic findings appeared in eighteen patients (47.3%). The frequency of pseudoaneurysm was statistically high in the Cesarean section (p < 0.001). The used embolic agents except gelfoam were N-butyl cyanoacrylate (n = 7), and microcoil (n = 7). Unilateral selective embolization (26.3%) was shown effective in superselective embolization of bleeding focus. Technical and clinical success rate were 100% and 97.4%, respectively with no complication. Sixteen resumed regular menstruation, and one pregnancy were observed in patients with available follow-up of over 6 months.
Conclusion: Considerable rate of hemodynamically unstable patients was observed with high rate of positive angiography findings. Given high successful rate and few complications, early angiographic assessment with embolization should be considered.
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KEYWORD
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Postpartum Hemorrhage, Angiography, Therapeutic Embolization, Cesarean Section
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